Provider Demographics
NPI:1629078464
Name:PHAM, DANIEL HA (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HA
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3105 IRA E WOODS AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3891
Mailing Address - Country:US
Mailing Address - Phone:817-421-2714
Mailing Address - Fax:817-421-2717
Practice Address - Street 1:3105 IRA E WOODS AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3891
Practice Address - Country:US
Practice Address - Phone:817-421-2714
Practice Address - Fax:817-421-2717
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2010-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL0903207Q00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1782278Medicaid
TXF85254Medicare UPIN